Sleep, Sleeping Pills And Other Alternatives, Part I

September 02, 2009
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Novus Medical Detox Center

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The Irish have a long list of proverbs that they love to quote. One of them is, “A good laugh and a long sleep are the best cures in the doctor's book.” All of us have experienced the curative powers of sleep. We have gone to bed feeling tired and generally out of sorts and felt completely different the next day. We have also experienced the problems if our sleep is not as good. We go to bed tired and wake up tired. Many of us can remember sleeping for long periods when we were young, and most of us always assumed that we would have no problems sleeping as we age. However, as we grow older, sleep seems to elude some of us. One of the most common fears expressed by patients who come to Novus Medical Detox Center to withdraw from alcohol, OxyContin, heroin, methadone, Vicodin, Percocet, oxycodone, Xanax or psychotropic drugs is that they won’t be able to sleep. You would think that something that seems so vital to so many of us would be better understood, but scientists are still struggling to unravel the mystery of sleep. In this two part newsletter we will first look at what the latest research tells us about sleep, and then next week we will look at the drugs and other methods used by people to help them sleep. WHAT IS SLEEP? Through our brain we communicate with all the parts of our body using chemicals called neurotransmitters. If we want to pick up a fork, the instructions from the brain travel from cell to cell via neurotransmitters and relay the instructions to our hand and fingers to pick up the fork. The brain, apparently often running on auto-pilot or responding to external stimuli like light, uses neurotransmitters to tell us to stay awake or sleep. Some scientists liken these signals to “On-Off” switches. When parts of our brain are turned off we sleep and when they are turned on we are awake. Some research also suggests that the concentration in the blood of a chemical called adenosine (a part of our DNA) increases while we are awake and eventually at the end of the day causes drowsiness which allows us to go to sleep. While we sleep, this chemical concentration decreases which then allows us to wake up and be alert. If we get too little sleep, we are drowsy and unable to concentrate the next day. If our inability to sleep becomes more serious, then hallucinations and serious mood swings may follow along with immune system problems. FIVE STAGES OF SLEEPStage One In Stage One, our eyes still move very slowly and our muscle activity starts decreasing and we can be easily awakened. In Stage One some of us experience sudden muscle contractions that are similar to how we jump if something startles us. Stage Two After being in Stage One for a time, we enter Stage Two. In Stage Two, our eye movements actually stop and our brain waves (electrical activity in the brain) slow. Stage Three The next stage is marked by delta waves (extremely slow brain waves) alternating with faster brain waves. Stage Four In Stage Four, the faster brain waves almost completely stop and delta waves predominate. When you are in Stage Three and Stage Four, it is very difficult for someone to wake us and we are said to be in “deep sleep.” In deep sleep there is almost no muscle activity or eye movement. If we are awakened during a deep sleep, we often feel groggy and disoriented. REM SLEEP After 70-90 minutes of being in the first four stages of sleep, we move to REM (rapid eye movement) sleep. During REM sleep, our breathing becomes more rapid and shallow and our eyes jerk rapidly. Our heart rate increases and our blood pressure rises. It is during the REM Sleep that we experience dreams. THE SLEEP CYCLE For most of us, these stages are repeated throughout the night with the time we are deeply sleeping decreasing and the time we are in the REM stage increasing. It is thought that we spend approximately fifty percent of our total sleep time in Stage Two sleep, about twenty percent in REM sleep, and the remaining thirty percent in the other stages of sleep. Stages Three and Four and REM sleep are the periods of sleep that provide that feeling of being refreshed and rested. FACTORS THAT CAN INFLUENCE SLEEP Anything that affects neurotransmitter signals in the brain can have an effect on our ability to sleep. We all know people who can drink coffee or a cola just before going to bed and still get a refreshing and relaxing sleep. However, for most of us, caffeinated drinks such as coffee and colas stimulate the activities of neurotransmitters that signal us to stay awake and prevent us from getting into the latter stages of sleep, even though we close our eyes and appear to be asleep. It is known that antidepressants often suppress REM sleep. Many of our patients who are detoxing complain that they have trouble sleeping and they are afraid that if they detox from the opioid or other drug, that they won’t be able to sleep. Many of them are taking antidepressants, and as they come off these antidepressants, along with becoming hydrated and getting vitamins and supplements, they find that they are able to sleep. To someone who has been having trouble sleeping, this is very exciting. Studies have shown that smoking can also suppress our ability to get into REM sleep and smokers often wake up frequently. Scientists believe that this is caused by feelings of nicotine withdrawal that occur during the night. There is a myth that one way to ensure that you can go to sleep is to have an alcoholic drink before bed. The fact is that drinking alcohol may help people fall into a light sleep but prevents most of us from ever getting into deep sleep and REM sleep. Many of us have been awakened feeling cold or hot. One of the things that occurs during REM sleep is that people are less able to regulate their body temperature. This explains why we sometimes wake up when the temperature in the bedroom rises or drops. HOW MUCH SLEEP DO WE NEED? The amount of sleep that we each need varies widely. Some are never rested unless they sleep eight hours and others seem to be rested after five hours. Whatever the amount of sleep a person needs, if he or she has been deprived of that amount of sleep in previous days, a sleep deficiency seems to occur. All of us have likely been very active for many days and getting less sleep that our body needed during that time, and then we fell asleep for a longer period of time than normal to “catch up.” One way of judging if you are getting sufficient sleep is that if you feel drowsy during the day, you probably haven’t had enough sleep. CONSEQUENCES OF SLEEP DEPRIVATION Sleep deprivation generally means not getting enough sleep. When people are consistently unable to get into deep sleep and REM sleep, then this condition becomes much more serious. People who are chronically sleep deprived:

Perform as badly as or worse than those who are intoxicated in driving simulators or in hand-eye coordination tests;

Are more affected by alcohol than well-rested people;

Are estimated to be responsible for an estimated 100,000 motor vehicle accidents and 1,500 deaths each year.

Another fact that points to the value of sleep are experiments done on lab animals. Lab rats normally live for two to three years. When these rats were not allowed to get into REM sleep, they only survived an average of five weeks. If the rats were not allowed to sleep at all, they died in an average of three weeks. Scientists speculate that the drastically shortened lives of these rats who were denied sleep may be attributed to the rebuilding of needed proteins during deep sleep and REM sleep. SLEEP DISORDERS The National Institutes of Health estimates that at least 40 million Americans each year suffer from chronic, long-term sleep disorders and an additional 20 million experience occasional sleeping problems. These disorders are grouped in four categories. These are:

Insomnia—inability to go to sleep;

Sleep Apnea—a disorder of interrupted breathing during sleep affecting as many as 18 million Americans which often wakes the person up in the middle of the night;

Restless Legs Syndrome-- unpleasant crawling, prickling, or tingling sensations in the legs and feet and an urge to move them for relief that is apparently often a side effect of drugs;

Narcolepsy—falling asleep during the day.

CONCLUSIONIn next week’s newsletter, we will discuss the drugs that people are using to supposedly help them sleep and their side effects. We will also discuss some natural alternatives. Although humorous, Woody Allen’s joke about sleep is probably not accurate. Mr. Allen said, “There are two types of people in this world, good and bad. The good sleep better, but the bad seem to enjoy the waking hours much more.” NOTE: This information is provided for general educational purposes only and is not intended to constitute (i) medical advice or counseling, (ii) the practice of medicine, health care diagnosis or treatment, or (iii) the creation of a physician patient or clinical relationship. If you have or suspect that you have a medical problem or that this information may be useful to you or others, please consult with your health care provider before applying any information from our articles to your personal situation or to the personal situation of others.

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